Benchmark Data and Laundry Applications Janice Carter Larson, CLLM Presented by Janice Carter Larson, CLLM Welcome. Thanks for getting up so early to attend my presentation. My name is Janice Larson and I am the Managing Director of Cost Management Services and Training for the Textiles and Interiors Division of Encompass LLC. In my 27 year career in healthcare, I have gone from selling every kind of medical supply you can imagine to remote third world hospitals on tiny little island nations in the Western Pacific, to teaching Total Quality Management to medical device manufacturers and hospitals, and ultimately to my current job leading a team of clinical nurse consultants to understand how healthcare linen is used and misused in hospitals. The experiences I had and the knowledge I gained during those years doing those other things uniquely positioned me to develop a job where I am constantly asking these two questions: “How can the healthcare industry find ways to eliminate waste and deliver higher quality care for less cost?” How can we help hospitals “steal shamelessly” the good ideas of other facilites and adopt them as their own in order to continually improve their processes?

Objectives Define “Benchmarking” Find out what kind of industry data is available Learn how to use industry data to benchmark and identify opportunities for improvement Those questions are at the heart of a concept called “benchmarking” which has it’s roots in TQM Total Quality Management (or CQI Continuous Quality Improvement as it is known in the healthcare industry). My objective this morning is to define what benchmarking is (and what it isn’t), look around the industry to identify some of the data tools that are out there in the textile industry that we can use to start the benchmarking process in motion, and then discuss what information these tools can provide that will enable us to identify which processes we might want to focus our continuous improvement efforts on.

Industry Data Reports Provide information on linen usage for inpatient, outpatient and surgical settings Help determine product replacement requirements Assist laundries and hospitals to set measurable goals for a linen utilization initiative Personally, I use a variety of industry data sources to help my hospital clients look at linen usage from many different aspects, including inpatient, outpatient and surgical applications. I also use these reports to help clients understand average product life and average replacement rates for textile products. This data can be very helpful when I am trying to explain to a healthcare executive with very little understanding of linen management why a bath towel doesn’t last for five years the way it does at home, or why they never seem to have enough scrubs or baby blankets. And most importantly, I use the data to help the hospital to establish a reasonable goal for their linen utilization efforts so that they have a tangible way to measure the results of all that hard work they have put into working with the departments to improve linen service and patient care.

Benchmarking Defined A process used in management in which organizations evaluate various aspects of their processes in relation to best practice usually within their own sector. This allows organizations to develop plans on how to adopt best practice and increase some aspect of performance. Benchmarking is often treated as a continuous process in which organizations continually seek to challenge their practices. Benchmarking, as defined by the TQM community, is evaluating the way you do things by comparing it to someone who does it better and cheaper. The goal of benchmarking is to adopt all or some of the better and cheaper process so that you can improve your own performance. An additional goal of benchmarking is to be continuously looking at additional ways to improve by seeking out more best practices from other sources and adopting those as well. The Japanese, specifically Toyota, called this “kaizen”, the healthcare industry, back in the early 1990’s dubbed it Continuous Quality Improvement (CQI).

Cause for Confusion “Best Practice” and “National Average” They’re not the same thing! However, there appears to be some confusion in our industry about the data that is contained in these reports. Generally the healthcare textile industry data we have available to us provides us with “National Averages” which are compiled from submissions from a specific group of survey participants, or from statistics taken directly from data entered into linen management software programs. Best Practices are quite another matter. A Best Practice, or a BDP Best Demonstrated Practice, a term used a lot in the healthcare arena, is a technique or methodology that, through experience and research, has proven to reliably lead to a desired result. National Averages are statistics and BDP’s are methods. So if anyone says “the BDP for linen use in a 500 bed hospital is 12.2 lbs/APD, they are not really referring to the BDP. 12.2 lbs/APD is the desired result. The actually BDP are the processes and products that contribute to that result and not the result itself.

Data Sources Encompass National Average Database The Phillips Report New Encompass NADB Reports Other Textile Provider Reports The industry sources I am going to be discussing are the National Average Database that my own company puts out (and for which I have management responsibility), the Phillips Report that is put out by Glen Phillips, Phillips and Associates, a laundry consulting firm out of Minnesota, a few of the new National Average reports that my team of nurse consultants are developing, and other reports from textile providers.

Hospital Data Variables Product quality Percentage of reusable OR linen Reusable incontinent products Number of departments authorized to wear hospital provided scrubs Please keep in mind when using any of these data sources that the statistical averages they provide contain a wide variety of product quality, Some hospitals have more reusable OR linen than others, some hospitals use disposable underpads rather than reusable underpads, and some hospitals provide hospital laundered scrubs to many departments, while some only provide them to the OR. I even have a few hospitals in Southern California who have moved to home laundered scrub programs.

Encompass National Average Database Designed for use primarily by hospitals Published every two years Data specific to linen usage Does not contain replacement cost information or average cost per pound Data pulled directly from computer reports, can now be done online Data analyzed for accuracy

Data Breakdown Average pounds per APD by total hospitals, by staffed beds, by region Average pounds per activity by inpatient, outpatient and surgical linen Average pounds per activity by specific department Average item usage per APD by total hospitals Includes ranges for reference purposes

“The Phillips Report” aka the 2005 North American Edition Comparative Operating Revenues and Expense Profile for the Healthcare Textile Maintenance Industry Designed for use primarily by OPLs, central and commercial laundries Published every two to three years

How do I get a copy? www.phillipsandassociates.com or (651)288-4950

Data Breakdown 17 Year Historical Cost Trends Average Linen Pieces and Pounds Used by APD for Hospitals and Nursing Homes Comparative Operating Revenue and Expense Profile Laundry Plant Textile Replacement Factors Laundry Plant Wage and Salary Profile

Other Benchmark Tools Children’s Hospital NADB Teaching Hospital NADB Level One Trauma Center NADB Reports available from other textile manufacturers, commercial laundry companies or industry organizations

Establishing a Baseline Where are we now? Where do we want to go?

Common Baselines Pounds per Adjusted Patient Day Annual Clean Pounds Processed Annual Adjusted Patient Day Cost per Adjusted Patient Day versus LBS per APD x Rate/LB Processing

Linen Management Software “Big Calculators” Provide data in a variety of report formats that enable you to set your baseline and track your progress against industry benchmark data Enable you to share information about your goals and progress with the end users or process owners

“Rational Consumption” the right product at the right time for the right reason in Linen items are consumable medical supplies designed to be used for specific purposes. Creative use = Cost abuse!!

Benchmarking Examples United Laundry Services, HI 9 hospitals, 2 Women and Children Same product, same rate per pound St. Joseph Health System, CA 7 hospitals in California Providence Health System, CA Two hospitals in SoCal

Benchmarking mistakes Confusing benchmarking with participating in a survey Confusing benchmarking with research Thinking there are pre-existing benchmarks for everything Choosing a process that is too large and complex to be manageable Choosing a topic that is too intangible and difficult to measure Goal is misaligned or cuts across other initiatives Not establishing a baseline Not researching the best practice thoroughly Forgetting about service, delivery and customer satisfaction

Key Points to Consider “Apples to apples” - compare your facility to another as similar as possible Use the data as a guide, not as an absolute Some of the most effective benchmarking is done within a hospital or hospital system

Keys to Success Set measurable goals Monitor progress, provide updates to participants to maintain motivation Publish results, include cost savings Continually review your current practice in order to identify opportunities for improvement

“Some people change when they see the light, others when they feel the heat.” Caroline Schoeder End the presentation with an uplifting video. When the video is completed, ask the group to fill out their evaluation forms. Thank the group for inviting me and allowing me to share my thoughts and ideas with them. 3